Fetal Surgery for Spina Bifida Leads to Better Mobility in School-Age Children
PHILADELPHIA: Adding to a growing body of research affirming the benefits of fetal surgery for spina bifida, new findings show prenatal repair of the spinal column confers physical gains that extend into childhood.
The researchers found that children who had undergone fetal surgery for myelomeningocele, the most severe form of spina bifida, were more likely than those who received postnatal repair to walk independently, go up and down stairs, and perform self-care tasks like using a fork, washing hands and brushing teeth. They also had stronger leg muscles and walked faster than children who had their spina bifida surgery after birth.
The findings were published today in JAMA Pediatrics.
This study shows that the benefits of fetal surgery for spina bifida extend beyond early childhood and well into a child's first decade of life, said N. Scott Adzick, MD, Surgeon-in-Chief at Children's Hospital of Philadelphia (CHOP), Director of CHOP's Center for Fetal Diagnosis and Treatment, and co-author of the study. This is especially important because of previously raised concerns that the advantages from fetal surgery may decrease over time. Contrary to those concerns, there appears to be a long-term benefit from neural protection in utero.
Spina bifida is a birth defect affecting up to 1 in 1,500 births in the United States and occurs when an area of the spinal column does not form properly, leaving a section of the spinal cord and spinal nerves exposed through an opening in the back. The condition often results in weakness or paralysis below the location of the defect, leading to an inability to walk unassisted and a loss of bladder and bowel control for many children.
MOMS2
To assess the long-term physical outcomes of patients receiving fetal surgery for spina bifida, the researchers assessed participants from the landmark Management of Myelomeningocele Study (MOMS) study, which was co-led by investigators at CHOP, Vanderbilt University Medical Center, and the University of California, San Francisco, along with the data coordinating center at the George Washington University Biostatistics Center and published in 2011 in the New England Journal of Medicine. That study compared outcomes of prenatal and traditional postnatal repair of myelomeningocele at 12 and 30 months and demonstrated that prenatal repair can offer significant benefits. Babies with spina bifida who received fetal surgery were less likely to need a shunt for the buildup of spinal fluid in the brain. They were also better able to walk two and a half years after surgery than those operated on after birth and had better overall motor function.
The researchers studied almost all of the children from MOMS when they were school-aged and in 2020 published the overall results of MOMS2 Follow up of the Management Of Myelomeningocele Study in Pediatrics. Focusing primarily on neurocognitive outcomes as well as motor skills, the researchers found that up to ten years after surgery, children who had received prenatal repair showed better gross and fine motor skills. They also continued to need fewer shunts, surgeries and catheterizations and reported better quality of life. In separate analyses they demonstrated better control over their bladder and bowel movements; children who underwent fetal surgery were almost six times as likely to go to the bathroom on their own than those operated on after birth. (PRN/1 day ago) https://www.newkerala.com/business-world-news.php
